Traps for the unwary

November 2010

Research

Predicting central sensitisation

Whiplash patients

Volume 39, No.11, November 2010 Pages 863-866

Robert Ferrari

Background

Central sensitisation is associated with chronic pain in whiplash patients. Predicting which patients will develop central sensitisation is difficult but patient expectations of recovery predict a variety of outcomes in whiplash patients.

Methods

Ninety-one whiplash patients were assessed within 1 week of their collision in order to ascertain their expectations of recovery and were then re-examined 3 months later with the Brachial Plexus Provocation Test (BPPT) as a sign of central sensitisation.

Results

Adjusting for a number of predictors, patient expectation of recovery was found to predict the results of the BPPT. Subjects who expected ‘to get better soon’ had a BPPT angle that was 42 degrees less (ie. closer to normal or full range) than any of the subjects who had poor recovery expectations.

Discussion

Whiplash patients who expect ‘never to get better’ or ‘don’t know’ have a much higher likelihood of developing at least one sign of central sensitisation 3 months after their collision.

Central sensitisation has been associated with chronic pain in whiplash patients, although the extent to which it is a result or a cause of chronic pain (or both) has not been fully elucidated.1 If prevention of central sensitisation is to be a goal of acute therapy in whiplash patients, as has been suggested,1 it would be helpful to have predictors of central sensitisation that could be used in the primary care setting, ideally without resorting to lengthy questionnaires, so that patients most at risk could be identified early and provided with appropriate treatments.

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Correspondence afp@racgp.org.au

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